Clinicians, researchers and physician-scientists from across the world gathered in Huntington Beach, California for a 2-day meeting that focused on the microbiome, its importance and how to best utilize the gut microbiome to possibly improve human health.

The Gut Microbiome Conference, which was held for the fourth time in October, included plenary lectures, interactive case-based presentations, and panel discussions on topics ranging from the microbiome’s connection to diabetes and obesity, as well as developing diagnostics and treatments for IBD.

Healio Gastroenterology and Liver Disease recently spoke with Mark Pimentel, MD, executive director of the Medically Associated Science and Technology (MAST) Program at Cedars-Sinai, and course co-director for the meeting, to discuss the highlights of the conference and what’s next.

Healio: What were some of the deciding factors that led you to want to develop this conference?

Pimentel: Let’s go back 10 years and to the community of people that were studying the microbiome. It was the beginning of the human microbiome project which was published in 2007 in Nature and it began this opening of the door to study the microbiome. But, everyone in that space, barring one or two people at that time were really PhDs working in labs crushing through numbers and figuring out how to do the molecular biology of it. But not MDs. And so, the doctors were hearing about so much interest in the microbiome, but questioned ‘how do we apply this to our practice?’ I have been interested in the microbiome on a clinical basis for quite some time and we wanted to build a meeting that brought together the basic science PhD people and the clinical people and say, ‘let’s put a program together where both can benefit because PhDs don’t know the clinical and the clinical people are saying, ‘what can I do in my clinic? How do I treat these patients?’ ‘They’re coming in asking about probiotics, synbiotics, fecal microbiota transplants and I need to know what to do because everyone is all excited about the microbiome, but what do we do to treat these people.’

Healio: What were some of the main take-home messages from the session that reviewed novel updates on the microbiome?

Pimentel: One of the most interesting things that I found is that the environment dictates the microbiome of a person’s body, for instance where and how you live. There’s a doctor, Jack Gilbert,from the University of Chicago who is conducting what is called the earth microbiome project where different parts of the earth, swamps, bogs and soil, all of that – the health of the soil and the microbiome – dictates the health of the planet, the health of the planet dictates the health of the human and also the microbiome of the human. Living on farms produces a different microbiome and protections against asthma as compared to not living on farms because of the exposures to the microbiomes and antigens of the microbiome. So, that was a really interesting lecture that has sort of a global look at how the microbiome in the whole world impacts us based on where we live.

Healio: The meeting included sessions on the virome, fungome, small intestinal biome and metabolome. Why is it important for physicians and in this instance, gastroenterologists, to understand the differences between them?

Pimentel: You have to think of your intestinal microbiome in a number of ways. First know that the microbiome helps you. When a person is in perfect homeostasis, the microbiome is in balance, highly diverse, and as a result is capable of fending off things. So, if a person’s microbiome is in good shape, they typically don’t get C. diff, and other viruses as much, as well as Crohn’s and other diseases. All of the diseases that are associated with the microbiome are related to the fact that the microbiome gets less diverse. For instance, it’s like being at a castle, there must be archers and warriors on horses and with swords. You have to have all these different components to fend off invaders. In the case of humans, you also need a full battalion of options. Same thing with the microbiome, when you’re missing those archers, you’re at risk. That’s sort of how the microbiome protects you. In addition, there’s the metabolome. That includes the list of components the bugs produce to help a person. An example of that is folate. Blood folate comes from bacteria, humans don’t easily produce folate. That’s just one example of a nutrient that the bugs make that a person benefits from.

Healio: What were some of the highlights from the discussion on microbiome updates related to diabetes and obesity?

Pimentel: We now know that there is an obese microbiome. In other words, if we take mice or humans that are obese and take the microbiome of the obese mouse or human and place it into a nonobese mouse or human, the mouse or human is likely to become obese. We know there is a phenotype of the microbiome that links to obesity and that’s a big finding. The question is, how do you unlock that and reverse that and engineer it so it’s not like that.

Healio: You led a discussion in a session on developing diagnostics and treatments based on the biome and focused on when products will likely hit the market. What did you talk about during your session?

Pimentel: That’s very exciting because there are various categories. For instance, one category is the probiotic approach, where we either know a bug that is really good, or we engineer a bug to do something really good for the human. There are companies developing engineered probiotics to treat C. difficile, for example. These could be among the first live bacteria that are approved by the FDA which is very interesting.

The second category is deriving a chemical from a bug. If we know that E. coli is producing this amazing chemical and it makes diabetes disappear, then can we isolate the chemical like we did for developing drugs from plants where, for instance, we take the plant and extract aspirin and make aspirin. In this case, we’re getting that chemical from bugs and it’s developing a “drug from a bug”.

The third arm is developing “drugs for bugs”, which is an approach I predominantly work on. Instead of giving a drug to a human that gets into their bloodstream and does something to the human, we give a drug, it stays in the gut (doesn’t get absorbed) and interferes with a disease-causing bug that is producing a chemical that makes people sick. If we knew a chemical produced by bacteria caused obesity, and we could block that chemical, then perhaps a person would not get obese.

Healio: The meeting’s website states that there will be a roll-out of three regional conferences starting this year. What led to that decision?

Pimentel: What’s happening these days is that a lot of doctors, because of Medicare and other cuts, don’t travel as much for conferences. We get comments asking us when we’re going to be on the East or Southeast coast, and if we could move the program around? The problem with moving the program around is some of the best microbiome people in the world are in California, so it’s easier to hold the meeting in California. But, we do have one coming up in New York, and then one in Chicago and in Dallas to cover the country.

Clinicians, researchers and physician-scientists from across the world gathered in Huntington Beach, California for a 2-day meeting that focused on the microbiome, its importance and how to best utilize the gut microbiome to possibly improve human health.

The Gut Microbiome Conference, which was held for the fourth time in October, included plenary lectures, interactive case-based presentations, and panel discussions on topics ranging from the microbiome’s connection to diabetes and obesity, as well as developing diagnostics and treatments for IBD.

Healio Gastroenterology and Liver Disease recently spoke with Mark Pimentel, MD, executive director of the Medically Associated Science and Technology (MAST) Program at Cedars-Sinai, and course co-director for the meeting, to discuss the highlights of the conference and what’s next.

Healio: What were some of the deciding factors that led you to want to develop this conference?

Pimentel: Let’s go back 10 years and to the community of people that were studying the microbiome. It was the beginning of the human microbiome project which was published in 2007 in Nature and it began this opening of the door to study the microbiome. But, everyone in that space, barring one or two people at that time were really PhDs working in labs crushing through numbers and figuring out how to do the molecular biology of it. But not MDs. And so, the doctors were hearing about so much interest in the microbiome, but questioned ‘how do we apply this to our practice?’ I have been interested in the microbiome on a clinical basis for quite some time and we wanted to build a meeting that brought together the basic science PhD people and the clinical people and say, ‘let’s put a program together where both can benefit because PhDs don’t know the clinical and the clinical people are saying, ‘what can I do in my clinic? How do I treat these patients?’ ‘They’re coming in asking about probiotics, synbiotics, fecal microbiota transplants and I need to know what to do because everyone is all excited about the microbiome, but what do we do to treat these people.’

Healio: What were some of the main take-home messages from the session that reviewed novel updates on the microbiome?

Pimentel: One of the most interesting things that I found is that the environment dictates the microbiome of a person’s body, for instance where and how you live. There’s a doctor, Jack Gilbert,from the University of Chicago who is conducting what is called the earth microbiome project where different parts of the earth, swamps, bogs and soil, all of that – the health of the soil and the microbiome – dictates the health of the planet, the health of the planet dictates the health of the human and also the microbiome of the human. Living on farms produces a different microbiome and protections against asthma as compared to not living on farms because of the exposures to the microbiomes and antigens of the microbiome. So, that was a really interesting lecture that has sort of a global look at how the microbiome in the whole world impacts us based on where we live.

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Healio: The meeting included sessions on the virome, fungome, small intestinal biome and metabolome. Why is it important for physicians and in this instance, gastroenterologists, to understand the differences between them?

Pimentel: You have to think of your intestinal microbiome in a number of ways. First know that the microbiome helps you. When a person is in perfect homeostasis, the microbiome is in balance, highly diverse, and as a result is capable of fending off things. So, if a person’s microbiome is in good shape, they typically don’t get C. diff, and other viruses as much, as well as Crohn’s and other diseases. All of the diseases that are associated with the microbiome are related to the fact that the microbiome gets less diverse. For instance, it’s like being at a castle, there must be archers and warriors on horses and with swords. You have to have all these different components to fend off invaders. In the case of humans, you also need a full battalion of options. Same thing with the microbiome, when you’re missing those archers, you’re at risk. That’s sort of how the microbiome protects you. In addition, there’s the metabolome. That includes the list of components the bugs produce to help a person. An example of that is folate. Blood folate comes from bacteria, humans don’t easily produce folate. That’s just one example of a nutrient that the bugs make that a person benefits from.

Healio: What were some of the highlights from the discussion on microbiome updates related to diabetes and obesity?

Pimentel: We now know that there is an obese microbiome. In other words, if we take mice or humans that are obese and take the microbiome of the obese mouse or human and place it into a nonobese mouse or human, the mouse or human is likely to become obese. We know there is a phenotype of the microbiome that links to obesity and that’s a big finding. The question is, how do you unlock that and reverse that and engineer it so it’s not like that.

Healio: You led a discussion in a session on developing diagnostics and treatments based on the biome and focused on when products will likely hit the market. What did you talk about during your session?

Pimentel: That’s very exciting because there are various categories. For instance, one category is the probiotic approach, where we either know a bug that is really good, or we engineer a bug to do something really good for the human. There are companies developing engineered probiotics to treat C. difficile, for example. These could be among the first live bacteria that are approved by the FDA which is very interesting.

The second category is deriving a chemical from a bug. If we know that E. coli is producing this amazing chemical and it makes diabetes disappear, then can we isolate the chemical like we did for developing drugs from plants where, for instance, we take the plant and extract aspirin and make aspirin. In this case, we’re getting that chemical from bugs and it’s developing a “drug from a bug”.

The third arm is developing “drugs for bugs”, which is an approach I predominantly work on. Instead of giving a drug to a human that gets into their bloodstream and does something to the human, we give a drug, it stays in the gut (doesn’t get absorbed) and interferes with a disease-causing bug that is producing a chemical that makes people sick. If we knew a chemical produced by bacteria caused obesity, and we could block that chemical, then perhaps a person would not get obese.

Healio: The meeting’s website states that there will be a roll-out of three regional conferences starting this year. What led to that decision?

Pimentel: What’s happening these days is that a lot of doctors, because of Medicare and other cuts, don’t travel as much for conferences. We get comments asking us when we’re going to be on the East or Southeast coast, and if we could move the program around? The problem with moving the program around is some of the best microbiome people in the world are in California, so it’s easier to hold the meeting in California. But, we do have one coming up in New York, and then one in Chicago and in Dallas to cover the country.